Medicare Coverage and Coding Guide

Medicare has limited coverage policies (MLCPs) for certain laboratory tests. Tests subject to an MLCP must meet medical necessity criteria in order to be covered by Medicare. MLCP tests ordered without a supportive ICD-10 code will not satisfy medical necessity and therefore will not be covered by Medicare. These orders must be submitted with an Advance Beneficiary Notice (ABN) signed by your patient, which confirms they are responsible for payment.

Navigating the complexities of MLCPs can be complicated, but Quest is here to help.

We’re pleased to provide Medicare Coverage and Coding Reference Guides to help you more easily determine test coverage and find ICD-10 diagnosis codes to submit with your test order. By doing so, you can ensure your Medicare patients’ lab tests are performed without delay and prevent disruptions to your office by not having to correct the information.

To get started, click on the state below where your Quest testing is performed:

J5 WPS

J6 NGS

J8 WPS

J15 CGS

JE Noridian

JF Noridian

JH Novitas

JK NGS

JL Novitas

JM Palmetto

JN-FSCO

There are Local Coverage Determinations (LCDs) issued by the Medicare Administrative Contractors (MACs) and National Coverage Determinations (NCDs) issued by the Centers for Medicare & Medicaid Services (CMS). The map above shows the different MACs that have jurisdiction over the testing. To view the full coverage policy (for any National Coverage Determination) from the CMS website, which will include a complete list of medically supportive ICD-10 codes, click here.